Search Results for "acupuncture"

Mar 12 2013

Another Acupuncture Meta-Analysis – Low Back Pain

As Carl Sagan observed, “randomness is clumpy,” which means that sometimes, for no specific reason, I write two or more blog posts in a row about the same topic. Perhaps it’s not entirely random, meaning that when a topic is being discussed related news items are more likely to come to my attention.

In any case, there was recently published yet another meta-analysis of acupuncture, this time specifically for low back pain. The findings and interpretation add to the pile of evidence for two important conclusions:

1 – Acupuncture does not work.

2- Acupuncturists refuse to admit that acupuncture does not work.

I would further infer from these two unavoidable conclusions the dire need for a greater understanding of the core principles of science-based medicine.

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60 responses so far

Aug 26 2011

Acupuncture and Acoustic Waves

Here is yet another study claiming to show “how acupuncture works” when in fact it does nothing of the kind. The bias of the researchers is so obvious in this study it’s astounding that it was published in a peer-reviewed journal. Of course, the mainstream media is dutifully reporting the biased claims of the researchers without any independent verification or analysis.

There are numerous fatal problems with this study. The first, like in many physiological studies that purport to be about acupuncture, is that the connection to acupuncture is tenuous. The researchers claim that they are testing the effects of an acupuncture needle – but what makes a needle an acupuncture needle? Other such studies were ultimately just seeing the effects of local tissue trauma. The fact that this trauma was induced by an “acupuncture needle” is not necessarily relevant.

This study is far worse, because it is simply using the acupuncture needle as a mechanism for inducing an unrelated physiological stimulus. This is similar to “electroacupuncture” where electrical current is applied through an acupuncture needle – what you are actually studying is the effects of electricity, not “acupuncture.”

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12 responses so far

Mar 25 2011

Another Acupuncture Fail

Here we go again. What if I said to you that drug X and a placebo of drug X (i.e. a placebo) worked better for the relief of a subjective symptom than no treatment, but no different from each other? I conclude from this that the “drug cohort” (whether the real drug or the placebo of the drug) did better than the no-treatment control group.  This may mean that the drug works through a general care effect and patient expectancy.

Let’s say, rather, that a pharmaceutical rep were saying this about their latest drug. It would be obvious that the drug company decided to use some Orwellian new speak in order to contrive a sentence in which they get to say that their drug works (by a general care effect). And in order to obscure the fact that their drug worked no better than placebo, they refer to both the drug and the placebo as the “drug cohort” and compare them both to a no-treatment group. The “drug cohort” had an effect.

In the real world of scientific medicine (not the bizarro world of CAM), when a treatment works no better than the placebo control we conclude that – the treatment does not work. Looking past all the obvious spin above, a more honest conclusion would simply be – drug X does not work for the tested symptom. Period. There is no “drug cohort”, and you don’t have to confuse the reader by calling placebo effects a “general care effect” or “expectation.” These are placebo effects.

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47 responses so far

Aug 20 2010

More Evidence that Acupuncture is a Placebo

I have written numerous blogs both here and on SBM about the acupuncture literature, which clearly shows that acupuncture, for any indication, is nothing but an elaborate placebo. Rigorous studies of acupuncture that actually try to isolate variables have shown that it does not matter where you stick the needles or even if you stick the needles – those variable do not have any specific effect. Acupuncture points and meridians are an illusion – nothing but superstition.

But there does appear to be a significant placebo effect, in addition to non-specific effects from relaxation and therapeutic attention, to the ritual of acupuncture. Does this mean “fake acupuncture works?” No – it means acupuncture does not work, but there are known placebo effects from the process of getting treated.

Now we have yet another study that supports the conclusion that acupuncture is just a placebo – but with an added element that is very interesting. Researchers compared traditional Chinese acupuncture (TCA) with sham acupuncture (non acupuncture points, shallow needle insertion) and another control group with no treatment for knee osteoarthritis. The researchers also did one very interesting thing, and one very sloppy and annoying thing (in my opinion). The sloppy thing was to use “electroacupunture” – which isn’t pure acupuncture. It’s acupuncture plus transcutaneous electrical nerve stimulation, which is an already proven modality for pain. In the TCA group they gave full “electroacupuncture” and in the sham group they gave less stimulation – enough to serve as an active placebo but not enough to have any effect.

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41 responses so far

Jul 29 2010

Acupuncture Pseudoscience in the NEJM

Here is the conclusion quoted from a recent New England Journal of Medicine (NEJM) review article on acupuncture for back pain:

As noted above, the most recent wellpowered clinical trials of acupuncture for chronic low back pain showed that sham acupuncture was as effective as real acupuncture. The simplest explanation of such findings is that the specific therapeutic effects of acupuncture, if present, are small, whereas its clinically relevant benefits are mostly attributable to contextual and psychosocial factors, such as patients’ beliefs and expectations, attention from the acupuncturist, and highly focused, spatially directed attention on the part of the patient.

Translation – acupuncture does not work. Why, then, are the same authors in the same paper recommending that acupuncture be used for chronic low back pain? This is the insanity of the bizarro world of CAM (complementary and alternative medicine).

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136 responses so far

Mar 11 2010

Acupuncture Does Not Work for IVF

Acupuncture is a so-called complementary and alternative medicine (CAM) modality I frequently tackle because it often provides excellent  teaching points on the relationship between science and the practice of medicine. My reading of the literature is that acupuncture is highly implausible and the evidence does not support its efficacy for any indication.

And yet it is one of the more popular CAM modalities (although still a small phenomenon – only 6% of Americans have ever used it), especially in its penetration of hospitals and academia. There is a great deal of misinformation out there about acupuncture, and this seems to garner the most attention from naive physicians.

In vitro fertilization (IVF) is one of the applications of acupuncture that has been most touted by proponents. The evidence for any positive effect from acupuncture for IVF, however, has been consistent with no effect. By this I mean that there are poor quality studies with mixed results, but trending positive (as poor quality studies tend to do), especially in China and other nations culturally predisposed to acupuncture, but the better designed studies tend to be negative.

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20 responses so far

Mar 03 2010

Acupuncture for Depression

One of the basic principles of science-based medicine is that a single study rarely tells us much about any complex topic. Reliable conclusions are derived from an assessment of basic science (i.e prior probability or plausibility) and a pattern of effects across multiple clinical trials. However the mainstream media generally report each study as if it is a breakthrough or the definitive answer to the question at hand. If the many e-mails I receive asking me about such studies are representative, the general public takes a similar approach, perhaps due in part to the media coverage.

I generally do not plan to report on each study that comes out as that would be an endless and ultimately pointless exercise. But occasionally focusing on a specific study is educational, especially if that study is garnering a significant amount of media attention. And so I turn my attention this week to a recent study looking at acupuncture in major depression during pregnancy. The study concludes:

The short acupuncture protocol demonstrated symptom reduction and a response rate comparable to those observed in standard depression treatments of similar length and could be a viable treatment option for depression during pregnancy.

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28 responses so far

May 12 2009

More on Acupuncture

Published by under Uncategorized

I am covering the in-patient service this month and so I am more busy than usual. I am trying to keep my blogging schedule without change, but it’s challenging, so forgive me if I occasionally miss a post or I am late.

For that reason, for my post today I am simply going to respond to a comment on my recent post on acupuncture and migraines. In response to this, frequent commenter, Sonic, wrote:

The conclusion that acupuncture does not work does not coincide with the evidence presented.

From the 2009 Cocrane review:

“Four trials compared acupuncture to proven prophylactic drug treatment. Overall in these trials acupuncture was associated with slightly better outcomes and fewer adverse effects than prophylactic drug treatment.”

This implies that acupuncture is a safe and effective treatment compared to the “proven” prophylactic drug treatment.

A drug company could go to the FDA with a study that showed their treatment to be better than the existing proven treatment and get approval based on that fact.

The conclusion that it is possible that the exact placement of the needles may not be as important as thought, does not invalidate the therapy.

Just because there might be a mistake in exactly how something works does not invalidate that it does work. The studies quoted would indicate that acupuncture works as well as or better than any other current therapy.

There is nothing in the evidence to indicate that the therapy did not work better than any existing therapy and better than doing nothing.

The fact that something works better than the proven therapy means that it works.

To conclude otherwise is to misread the evidence as presented.

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35 responses so far

May 07 2009

Obama’s Health Initiative – Acupuncture for Migraine

Published by under Uncategorized

It must be tough being a highly visible politician – specifically taking questions from the public. You can get hit with highly technical questions in any area, often posed by someone with a narrow agenda and a great deal of information with which they can plan rhetorical mines. I don’t expect politicians to have all the technical details for any such issue at their fingertips. Experienced politicians, however, have learned how to handle such situations – the first rule of which is not to pull facts out of your butt.

George Bush’s most famous such gaffe, in my opinion, is when he said that the “jury is still out” on the question of evolution. Right – only greater than 98% of all scientists agree that evolution is a scientific fact, but we’re still waiting on the other 1% or so of hold outs.

Obama is not likely to get tripped up on the evolution issue, but he is vulnerable when it comes to science and medicine. Unscientific medical modalities and practitioners have found allies on both sides of the political aisle. The impending health care reform has also mobilized the CAM (complementary and alternative medicine) troops who are trying to twist the health care agenda to serve pseudoscience.

At a recent town meeting Obama received the following question and gave the following answer:

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17 responses so far

Nov 17 2008

Through the Looking Glass of Acupuncture Research

Published by under Skepticism

Clinical research tends to follow a certain arc: first smaller and preliminary studies are done to see if there is a potential for a new treatment or approach, then larger and more tightly designed studies are done exploring the relevant research questions, and finally large, double-blind, placebo-controlled consensus trials are completed and the basic question of efficacy is settled.

In scientific jargon we often talk about the null hypothesis, the hypothesis that a new claim is not true, or in the context of medicine that a new treatment does not work. The question for a study is framed as follows: does the data support the rejection of the null hypothesis. This is not a subtle or unimportant distinction, it puts the burden of proof on demonstrating the positive new claim – that a treatment works. Unless the data compels us to reject the null hypothesis, it is retained as the default conclusion. Therefore, in these large and well-controlled trials, if the treatment does not work consistently and both clinically and statistically significantly better than placebo, we do not reject the null hypothesis. In practice we conclude that the treatment does not work and it is appropriately discarded in favor of better treatments or new ideas.

Unless of course you live in the alternate universe of acupuncture research (or more generally that of complementary and alternative medicine – CAM).

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6 responses so far

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